Provider Demographics
NPI:1336393875
Name:SANJABI, PARVIZ B (MD)
Entity Type:Individual
Prefix:
First Name:PARVIZ
Middle Name:B
Last Name:SANJABI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 577
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-0577
Mailing Address - Country:US
Mailing Address - Phone:618-985-8221
Mailing Address - Fax:618-985-6860
Practice Address - Street 1:1335 CEDAR COURT
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901
Practice Address - Country:US
Practice Address - Phone:618-457-8520
Practice Address - Fax:618-457-8560
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051114207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051114Medicaid
ILCF3444OtherMEDICARE RR GROUP
IL133133805OtherDOL BLACK LUNG
IL370966854018Medicaid
IL640701001OtherMEDICARE PTAN
IL036051114Medicaid
IL370966854018Medicaid
ILCF3444OtherMEDICARE RR GROUP